Making a Difference in Workers’ Compensation Claims
Great to be here.
Awesome. So here's where I'd like to start, right? We talk all the time, especially here in HR about getting people into our industry. Right. A lot of people don't necessarily go to college or go to school to get a job in the insurance industry. So I'd love to hear from both of you, how did you find your way into workers comp and claims and, and your jobs at A.I.M. Mutual?
Well, I'll go first and I think you're lucky because me and Lorraine actually probably covered the two main ways that people do find the way into insurance and you're right. I did not go to school for it and do not have a degree in insurance, but, I had a lot of customer service over the years, just some various jobs like movie theaters, bookstores, deli, you know, you name it. And then I was at a temp agency and this job came along and I said, why not? And five years later, I'm still here.
I was doing, I was at another company for 17 years doing transportation. And it was just, it got to the point where I was to get, like, getting burnt out and I just didn't want to do it anymore. So I just, I didn't know where to go, what I wanted to do. And, there's another adjuster here, Robin, that is a family friend. So I was always listening to her, telling her stories about her job. And I'm like, oh my God, your job sounds so much fun. Like, what exactly do you do? So she got to talking about it and everything else. And I loved hearing her stories every time I got to see her. So a position opened up and she's like, Hey, I know that you're looking for a job and everything else. Why don't you apply and see what happens? So I did and obviously I got the job and I've been here for five years almost. I never thought insurance. I mean, I had friends that worked in insurance before and I'm like, that's boring. Like who would want to work in insurance? And honestly, like, I love it. It's never a dull moment, and the people I work with are okay. (laughter)
You know, it's really interesting because, I hear a lot of the same things out in the world. Right. So, you either get in the industry because you had transferable skills like customer service, right. Ben like you worked a lot with the public and you worked on the phones and then Lorraine, the other side of it is, a lot of people are referred into the industry. They know someone in the industry and they say, Hey, it's a great industry to work for. So we hear that a lot. We hear that a lot. That's awesome. So you guys are both returned to work specialists. We know that most people that are injured on the job are anxious to get back to work and recover. Are there any kind of cases that jump to mind that kind of stick out as, as success stories?
Individual claims tend not to stick with you unless, usually if, something bad happens with them. But I will say, you know, you get the, every once in a while, you get a claimant who is just so eager to get back to work, that they boggle the mind. Like I had, not too long ago, I had this one guy who had back surgery. And normally you expect people to be out after back surgery for at least a few months if they ever go back to work and he really pushed the doctor and was back to work, I think it was like a week or two after surgery and stuff like that. And you know, it doesn't happen very often that way, but it's nice when it does.
I just had one. I mean, there was a, she was an older woman. She had a left ankle fracture, had surgery, had pins put in. There was a nurse assigned to the claim and she was following her. We were fully convinced that she was never going back to work. She was about, I want to say she's like 72, 73 years old and we're like, okay, between the injury, her age. She's never going back. And now here it is three months later and she has a full duty release to go back to work. And she was anxious to go to work. She missed her clients. Yeah. So that's like one that I can really think of. That's more recent that kind of sticks out. But like Ben says, I mean, there's so many of them that kind of just come and go, there’s not one particular one you could pinpoint that's special over another.
Interesting. So how about the other side of the coin, right. I'm sure you guys would agree. There's probably some people that you need to nudge, you know, maybe, you know, maybe give them a little push here and there. How do you handle that? How do you reach those folks?
Depends. Sometimes it takes litigation, attorneys, the whole nine yards and sometimes it takes heavy hand. Let them know that there's, you know, no nonsense. Sometimes it takes a carrot just sticking it in front of them. Yeah. You really have to like pick and choose and strategize based on the individual themselves. Like there's no cut and dry do this and that will work every time.
And kind of, it kind of sounds, that's one of the things that makes the, the job interesting. Right. It's never the same thing. It's never cookie cutter. It's never vanilla, right?
No, no, it'd be nice if it was, if there was like one rule book to say, Hey, this is what happens here and everything else, but like every claim is different. I mean, we have a bunch of tools that are given to us, like IME's and medical directors and surveillance to kind of use before we are able to like really pull the trigger on anything. And then, I mean, worst case scenario, if we think that someone's trying to beat the system and like milk it and stay out of work for the summer, basically, you can do benefits once you go through all your like buckets of stuff, resources.
Of resources, right? I'm glad you mentioned resources. It's a nice segue. Because I wanted to ask you about how it works in the claim department, right. Um, do you handle claims individually? Would you say you collaborate with a team or teammates? How does that work?
Oh my God. I drive Ben crazy all day.
There you go.
Every single day, all day, he sits across from me, so I will just stand up and like just start spouting stuff off to him. And like, what do you think of this? And what do you, you think of that and how do you do this? And then like if we're on, if we're home, working from home, we'll go on Teams and we'll ask questions on there. We'll Teams our supervisor.
All teams usually are focused on a certain area of the map but we still, you know, talk to each other all the time. Like Lorraine said just bouncing ideas off each other, trying to figure out the best thing to do in any given situation.
It seems like you guys are really into your job and you like your job. I mean, you guys have been here for five years, right? What's the, what's the biggest myth about working in workers comp and working in the claims department?
So I saw this question coming and I am turning it back on you because as an adjuster, we might not always be sensitive to what myths there are out there. So you, someone who has never been an adjuster, what do you think is a myth or something?
Love how you did that. Ben, I love how you did that. Wasn't expecting that at all. But I got an answer for you. So I think for me, the biggest myth that I hear and kind of sense is is that it's all bad news, right? You're always dealing with bad things. Obviously we try our, our goal is to help people, but it just seems like it's all a lot of bad news.
And it does sometimes feel like that. Like I think I said before, the claims that are good, where people go back to work, you don't necessarily need to invest a lot of time in; it is the bad claim that you do have to pay attention to and go through litigation and all that. So it can feel like that's all we do. But in reality, the vast majority of people who are injured go back to work. So like I said, it doesn't seem like it. But if you factor in all, all of the claims where people aren't losing time from work, if you factor in every claim that comes into the claims department, the majority of them are going back to work eventually not immediately, but eventually sure.
That's another great myth, right?
Yeah. Yeah. And I think, and then the whole dealing with like personal health insurance is not fun. You have to jump through hoops and everything else. And I think people, when they get hurt kind of feel that they have to do the same thing when it comes to us that we're not going to be like compassionate and feel bad and try and help them out. So I think that right off the bat, most of them have that "you're out to get me" attitude.
Yeah, exactly. Like there's definitely is a myth out there that we just are out to get them. And everyone, a lot of people have had interactions with insurance, if not workers comp. I remember I was in a fender bender and me having experience with insurance was still having to go I, I think I talked to a different auto adjuster every single time I called and I knew what I was doing. So it's easy to, to think that the adjuster just doesn't care about you at all. But one thing I always like to point out is that we want people to go back to work because that makes our life easier. It can be as simple as that we want people to go back to work to get better.
Right, right. Absolutely. And that's what we're all about. We're all about helping people and being compassionate and empathetic and, and doing the right thing. Right. So, right.
And I would think that just, I mean, I want to do the right thing.
And that's what I always try to do.
I mean, I tell them when I first talk to them I say, listen, I'm here to like get you better. But ultimately my job is to get you back to work, to make sure that like, you're not going to hurt yourself again. And like, what can we give you to make sure that this doesn't happen and that you're not back on the phone with me back out of work.
So, absolutely and that's why we call you return to work specialists. Right? That's the, that's the ultimate goal. Well, that's awesome. Well, listen, I want to thank you both for your insight into the claims process and, and kind of your world. I want to thank our listeners for spending time with us today. Please feel free to reach out with any thoughts or questions you might have and be sure to tune in for our next topic and check out all of our podcasts on Apple podcast or Spotify. So thanks, Ben. Thanks, Lorraine.